The plantar fascia arises from the medial tuberosity of the calcaneous and extends to the proximal phalanges of the toes.
Pkantar Fasciitis is the most common cause of heel pain in adults.
Etiology is thought to be from a degenerative tear at the fascial origin followed by a tendinosis type reaction and .
Affects women 2x> men
More common in overweight patients.
Onset is insidious and not related to trauma.
Hx: Pain and tenderness directly over the medial calcaneal tuberosity and 1-2cm distally along the plantar fascia.
Pain is worse with prolonged standing/walking. Pain is most intense however when rising from a resting position such as first thing in the morning.
PE: Pain is increased with passive dorsiflexion of the toes. Tenderness to palaption over the medial calcaneal tuberosity and 1-2cm distally along the plantar fascia.(At times, one may have to apply increased pressure to approximate weight bearing type stress)
XR: Usually not necessary with a good history and exam. Heel spurs are seen in up to 50% with the disease (and in up to 20% without it!)
DDx: Tarsal tunnel syndrome. Calcaneal stress fracture. Fat pad atrophy. traumatic rupture of planter fascia.
